Indiviudal Health
Enrollment Forms
Complete the
Enrollment Application (PDF). Only one application is necessary
per family.
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Apply
Online You may either apply directly online now
or print out and complete the enrollment forms ( see below). |
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Lifewise
Individual Application
- Download Now
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To print an application
simply click on the link above and then print, or you
may choose to apply online now.
You Will also need to complete a
Standard Health
Questionnaire for each person applying for coverage
unless you meet one of the exclusionary
requirements as outlined on the application.
If you are applying online the Questionnaire to complete
will be provided to you through the online process. |
Send all Enrollment Materials to:
Lifewise of Washington
PO Box 91120
MS 295
Seattle, WA 98111-9220
You can choose from two effective dates – the 1st or 15th of
the month. For a 1st of the month effective date, applications
must be postmarked by the 20th of the previous month. For a 15th
of the month effective date, applications must be postmarked by
the 5th of the same month.
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Regence BlueShield
Individual Application
- Download Now |
To
print an application simply click on the link above and
then print. You Will also need to
complete a
Standard Health
Questionnaire for each person applying for coverage
unless you meet one of the exclusionary
requirements as outlined on the application.
Quoteselect Insurance
Agency Id Number W02443 |
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Please do not send a rate payment with your application. You will receive a
statement from Regence BlueShield upon acceptance of your application.
Send all Enrollment Materials to:
Regence Blue Shield
PO Box 91053
1800 Ninth Ave
Seattle, WA 98111-9153
Please note: All COMPLETED enrollment materials
should postmarked on onr before the 20th of the of the month for coverage to
become effective the following month.
Incomplete enrollments may cause delays in the effective date of your
coverage. Please refer to the checklist included with the application to avoid
delays.
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KPS
of WA Individual/ Application
- Download Now
To print
an application simply click on the link above and then
print.
You Will also need to complete a
Standard Health
Questionnaire for each person applying for coverage
unless you meet one of the exclusionary requirements
as outlined on the application.
KPS requires a check along with your
enrollment materials for the first months premium made
payable to KPS
Health Plans.
Send all Enrollment Materials to:
KPS Health Plans
PO Box 339
Bremerton, WA 98337-0039
Please note: All COMPLETED
enrollment materials should postmarked on onr before the
20th of the of the month for coverage to become effective
the following month.
Incomplete enrollments may cause delays in the effective
date of your coverage. Please refer to the checklist
included with the application to avoid delays.
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